Spine Journal最新文献

{"title":"Evaluating the predictive value of K-line conversion in surgical outcomes for K-line negative cervical ossification of the posterior longitudinal ligament (OPLL): laminectomy with fusion versus laminoplasty.","authors":"San Kim, Sehan Park, Chang Ju Hwang, Jae Hwan Cho, Dong-Ho Lee","doi":"10.1016/j.spinee.2025.05.015","DOIUrl":"10.1016/j.spinee.2025.05.015","url":null,"abstract":"<p><strong>Background context: </strong>Laminectomy with fusion (LF) and laminoplasty are common treatments for K-line negative cervical ossification of the posterior longitudinal ligament (OPLL). However, the clinical significance of postoperative K-line conversion from negative to positive remains unclear.</p><p><strong>Purpose: </strong>To determine whether converting a K-line from negative to positive improves surgical outcomes in patients with cervical OPLL by comparing LF and laminoplasty.</p><p><strong>Study design/setting: </strong>Retrospective cohort study.</p><p><strong>Patient sample: </strong>Patients with cervical myelopathy due to K-line negative OPLL who underwent LF or laminoplasty, with ≥1 year of follow-up.</p><p><strong>Outcome measures: </strong>Primary outcomes included neck and arm pain visual analog scale (VAS) scores, neck disability index (NDI), Japanese Orthopedic Association (JOA) score, JOA recovery rate, and radiographic parameters (C2-C7 lordosis, modified K-line interval).</p><p><strong>Methods: </strong>We compared radiographic and clinical outcomes between the 2 groups.</p><p><strong>Results: </strong>Among 85 patients with K-line-negative OPLL (39 LF, 46 laminoplasty), postoperative K-line conversion occurred significantly more frequently in the LF group (56.4% vs. 16.8%; p<.001). Although laminoplasty better preserved cervical range of motion and reduced neck pain, LF provided superior neurologic outcomes, as indicated by higher final JOA scores and recovery rates. Patients who achieved K-line conversion had significantly higher rates of favorable clinical outcomes compared to those who did not (58.1% vs. 27.7%; p=.019). Multivariate regression analyses further demonstrated that K-line conversion independently predicted favorable clinical outcomes (odds ratio [OR]: 3.900; p=.023), and LF was significantly associated with a higher likelihood of K-line conversion compared to laminoplasty (OR: 3.683; p=.033).</p><p><strong>Conclusion: </strong>In patients with K-line-negative cervical OPLL, postoperative conversion to K-line-positive status is significantly associated with improved neurological outcomes. Although laminoplasty provides advantages regarding neck pain relief and motion preservation, LF more reliably facilitates K-line conversion and suppresses kyphosis, leading to superior clinical outcomes. Careful preoperative evaluation of cervical alignment, combined with surgical strategies aimed at promoting K-line conversion, may optimize surgical results.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Academic and demographic characteristics of spine societies' presidents","authors":"Lancelot Benn MD ,&nbsp;Gonzalo F. Del Rio Montesinos MS ,&nbsp;Mina Botros MD ,&nbsp;Ram Haddas PhD, MBA ,&nbsp;Addisu Mesfin MD","doi":"10.1016/j.spinee.2025.05.019","DOIUrl":"10.1016/j.spinee.2025.05.019","url":null,"abstract":"<div><div>There is limited information on spine society presidents' training backgrounds, academic productivity, and demographics. This is crucial because the individuals elected to this role are thought leaders and can impact the future trajectory of spine surgery. The paper characterizes the training backgrounds, academic productivity, and demographics of presidents elected to serve in 7 spine societies: Scoliosis<span> Research Society (SRS), Cervical Spine<span><span> Research Society (CSRS), North American Spine Society (NASS), Lumbar Spine Research Society (LSRS), International Society for the Study of the Lumbar Spine (ISSLS), American Association of Neurological Surgeons Spine (AANS Spine) and International Society for the Advancement of Spine Surgery (ISASS). This was a retrospective cohort study of 7 spine society presidents (n=156) from 2000 to 2024. The information was retrieved via society websites for the SRS (n=24), CRSR (n=25), NASS (n=25), (n=25), ISSLS (n=25), AANS Spine (n=25), and ISASS (n=23). LSRS provided their list of presidents (n=9) upon request. Training backgrounds, current academic productivity, and demographic characteristics were obtained from online curriculum vitae, academic websites and Scopus. Data collection occurred from June 19, 2024 to September 14, 2024. Most presidents (95.5%) were surgical providers (orthopedic surgeons 106/156, 67.9%; 43/156, 27.6% neurosurgeons). Only 7/156 (4.5%) were nonsurgical providers. CSRS and SRS presidents had the highest cumulative publications and H-index, respectively. The academic rank at appointment was professor for 122/156 (78.2%) presidents. Of the 156 presidents, 12.9% were MD/PhDs. There were 150/156 males (96.2%), and 122/156 were white (78.2%). Spine society presidents are mostly male </span>orthopedic<span> surgeons with high scholarly output. Most had the academic rank of professor. As orthopedic and neurosurgery training programs become more representative of the population, more leaders from diverse backgrounds may become future presidents of these societies.</span></span></span></div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 10","pages":"Pages 2170-2177"},"PeriodicalIF":4.7,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hounsfield unit measurements to predict odontoid fracture union in elderly patients: post-hoc subgroup analysis from an international prospective comparative study.","authors":"Jeroen G J Huybregts, Wilco C H Jacobs, Luc W F van Haaster, Emma K Ruitenbeek, Mark P Arts, Michael Osti, Willem-Bart M Slooff, F Cumhur Öner, Sasha Gulati, Natasha M Appelman-Dijkstra, Ewout W Steyerberg, Geert J Lycklama À Nijeholt, Wilco C Peul, Carmen L A Vleggeert-Lankamp","doi":"10.1016/j.spinee.2025.05.011","DOIUrl":"10.1016/j.spinee.2025.05.011","url":null,"abstract":"<p><strong>Background context: </strong>Decreased bone mineral density (BMD) has been associated with worse fracture healing in vertebral fractures. In the absence of dual-energy X-ray absorptiometry (DXA) scans, CT-derived Hounsfield units (HU) may serve as a surrogate marker for BMD.</p><p><strong>Purpose: </strong>To study whether baseline HU measurements in the C2 and C3 vertebrae could predict odontoid fracture union in elderly patients.</p><p><strong>Study design/setting: </strong>Subgroup analysis from an international prospective comparative study.</p><p><strong>Patient sample: </strong>142 prospectively included patients aged ≥55 years with acute (<2 weeks) type II/III odontoid fractures.</p><p><strong>Outcome measures: </strong>Fracture union at 52 weeks.</p><p><strong>Methods: </strong>Standardized HU measurements were obtained from baseline CT scans in both mid-sagittal and mid-axial planes of C2 and C3. Fracture union at 52 weeks was compared between patients with and without union. Multivariable regression analyses with fracture union as the dependent variable adjusted for age, gender, fracture type, fracture displacement, other C1-C2 fractures, and treatment modality.</p><p><strong>Results: </strong>There were no relevant differences in HU values between the union and nonunion groups. Mean (SE) C2 HU was 246 (6.3) in the union group vs. 282 (33) in the nonunion group (p=.29), and mean C3 HU was 260 (6.5) vs. 251 (15), respectively (p=.56). No association was found between baseline HU and fracture union (aOR 1.00 (95% CI 0.99, 1.01) per HU increase for both C2 and C3). None of the baseline characteristics were significant predictors of union at 52 weeks. Compared to control patients in the literature, both the union and nonunion groups had reduced HU (cervical HU <300), indicating osteopenia.</p><p><strong>Conclusions: </strong>Baseline HU measurements in C2 and C3 did not predict fracture union at 52 weeks. Given that both groups exhibited decreased BMD, all elderly patients with odontoid fractures should be referred for osteoporosis screening and appropriate treatment.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiation exposure in XLIF surgery utilizing ultra-low radiation imaging with image enhancement software: a randomized controlled trial.","authors":"Benno Bullert, Jula Gierse, Eric Mandelka, Paul A Gruetzner, Sven Y Vetter","doi":"10.1016/j.spinee.2025.05.013","DOIUrl":"10.1016/j.spinee.2025.05.013","url":null,"abstract":"<p><strong>Background context: </strong>Minimally invasive spine surgery has grown significantly over the last decade. Lateral approaches for interbody fusion, such as XLIF/LLIF result in higher radiation exposure for the operating room (OR) staff and the patient compared to posterior techniques. New technologies such as ultra-low radiation imaging (ULRI) combined with image enhancement (IE) software may help reduce this exposure while maintaining procedural efficacy.</p><p><strong>Purpose: </strong>To evaluate whether using ULRI with IE software (mFluoro) reduces radiation exposure for OR staff and patients during lateral interbody fusion via the XLIF approach without increasing procedure time.</p><p><strong>Study design: </strong>Prospective, randomized controlled trial.</p><p><strong>Patient sample: </strong>The sample consists of 60 patients.</p><p><strong>Outcome measures: </strong>Primary outcome: Radiation exposure of the OR staff, measured in microsieverts (μSv), documented by personal dosimetry centrally in front of the sternum above the lead apron.</p><p><strong>Secondary outcomes: </strong>Radiation exposure of the patient, measured in cGy*cm², documented by the fluoroscopy unit's dose report; Procedure time, measured in minutes.</p><p><strong>Methods: </strong>This single-center prospective randomized controlled single-blind study included 60 patients who all underwent single-level lateral interbody fusion via XLIF approach between March, 2023 and December, 2024. Patients were randomized into two groups: intervention group (mFluoro) or control group (cFluoro). Radiation exposure of the OR staff was measured using dosimeters, and imaging parameters were extracted from the fluoroscopy unit's dose report.</p><p><strong>Results: </strong>No significant difference was found between the two groups regarding age, gender, BMI, implant type, and diagnosis (all p>.05). The mFluoro group showed a significant reduction in radiation exposure for the OR staff: 72.1% for the surgeon (p<.001), 76.1% for the assistant (p<.001), and 67.5% for the scrub nurse (p<.001). Patient radiation exposure was also significantly reduced in the intervention group, with dose area product (DAP) values lowered by 66.1% (p<.001). Fewer images were acquired in the mFluoro group (31.3% reduction, p<.001), and procedure time was reduced by 17.7% (71.3±21.3 minutes vs. 86.6±31.5 minutes; p=.034).</p><p><strong>Conclusion: </strong>Using ULRI with IE software significantly reduces radiation exposure for the OR staff in single-level lateral interbody fusion via the XLIF approach. Furthermore, the radiation exposure for the patient was also significantly reduced.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidomain postoperative recovery trajectories after lumbar and thoracolumbar spine surgery.","authors":"Salim Yakdan, Jingwen Zhang, Braeden Benedict, Ziqi Xu, Saad Javeed, Justin K Zhang, Benjamin A Steel, Vivek P Gupta, Kathleen Botterbush, Jay F Piccirillo, Thomas L Rodebaugh, Burel R Goodin, Jacob M Buchowski, Brian Neuman, Daniel Hafez, Michael Kelly, Wilson Z Ray, Chenyang Lu, Madelyn Frumkin, Jacob K Greenberg","doi":"10.1016/j.spinee.2025.05.017","DOIUrl":"10.1016/j.spinee.2025.05.017","url":null,"abstract":"<p><strong>Background context: </strong>Understanding early postoperative recovery is crucial for improving perioperative care and long-term outcomes. Traditional recovery assessments relying primarily on cross-sectional patient-reported measures may not fully capture the complexity of the recovery process.</p><p><strong>Purpose: </strong>Our study evaluates early postoperative recovery using mobile health assessment and explores the relationship between early recovery patterns, multidomain recovery, and long-term outcomes.</p><p><strong>Study design/setting: </strong>A prospective observational study.</p><p><strong>Patient sample: </strong>A total of 129 patients were included in the analysis.</p><p><strong>Outcome measures: </strong>Patient-reported outcome measures (PROMs) of pain, physical function, and disability at 1, 6 and 12 months postoperatively.</p><p><strong>Methods: </strong>This study recruited patients aged 21 to 85 undergoing lumbar/thoracolumbar surgery for degenerative diseases. During the first month postoperatively, patients completed daily Ecological Momentary Assessment (EMA) surveys assessing pain, depression, and physical function and were passively monitored with Fitbit. EMA and Fitbit data (steps per minute, Maximum 30-minute cadence, and activity bout number) were clustered using functional principal component analysis.</p><p><strong>Results: </strong>129 patients were included (median age: 62; 56% female). Two dominant recovery patterns were identified across all domains. At 12 months, patients with more favorable recovery across all domains except for activity bout number and depression, showed better outcomes. Favorable recovery in pain intensity and steps per minute was associated with greater improvements in all outcomes, while favorable recovery in maximum 30-minute cadence was associated with greater improvement in disability and physical function. Patients with less favorable pain recovery had a significantly higher complication rate (23% vs. 7%). A greater number of favorable recovery domains was associated with better 12-month outcomes improvement and demonstrated superior prognostic value compared to traditional patient assessment methods.</p><p><strong>Conclusion: </strong>Early postoperative recovery patterns and multidomain recovery, captured using mHealth tools, provide valuable insights into long-term outcomes. With further validation, these findings highlight the potential of integrating mHealth into clinical practice to personalize rehabilitation strategies, improve resource allocation, and enhance patient care.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical disc replacement in athletes: a modified Delphi Consensus Survey of expert opinion.","authors":"Scott L Zuckerman, Jacob Jo, Grant H Rigney, Julian E Bailes, Christopher M Bonfield, Robert C Cantu, Patrick C H Chan, Andrew M Cordover, Domagoj Coric, Hank Feuer, Raymond J Gardocki, Andrew C Hecht, Wellington K Hsu, Jacob R Joseph, Ronald A Lehman, Allan D Levi, Susan M Liew, Philip K Louie, Steven C Ludwig, Joseph Maroon, Vincent J Miele, Jeff Mullin, Venu M Nemani, Frank M Phillips, Sheeraz Qureshi, K Daniel Riew, Myron A Rogers, Rick C Sasso, Gabriel A Smith, Jay D Turner, Alexander R Vaccaro, Robert G Watkins, Nicholas Theodore, David O Okonkwo, Allen K Sills, Gavin A Davis","doi":"10.1016/j.spinee.2025.05.009","DOIUrl":"10.1016/j.spinee.2025.05.009","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;The safety and efficacy of cervical disc replacement (CDR) for spinal disorders in contact sport athletes is unclear. Current research is limited and highlights mixed results regarding return-to-sport (RTS) among athletes with CDR.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;We sought to perform a modified Delphi consensus survey of expert opinion on CDR in athletes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;A cross-sectional, modified Delphi consensus survey of different scenarios regarding RTS for athletes with CDR was conducted among a panel of expert spine surgeons.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient/respondent sample: &lt;/strong&gt;An international panel of 34 spine surgeons involving both neurosurgeons and orthopedic surgeons with sport expertise was identified.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Consensus regarding return to any level of sport as defined above was queried as the main outcome measure, with consensus defined a-priori at ≥70%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A 2×2 scheme was used to classify sport risk: 1=low impact/low frequency; 2=low impact/high frequency; 3=high impact/low frequency; 4=high impact/high frequency that also served as the different levels of sport that respondents could recommend returning to for the theoretical athlete. Descriptive statistics were performed with survey respondent data to generate the percentages of respondents recommending return to each level of sport for all scenarios.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 34 sports spine surgeons invited to participate (55.9% neurosurgeons and 44.1% orthopedic surgeons), all completed nine questions as part of a larger survey. Regarding radiculopathy, consensus was achieved that CDR is an acceptable treatment for cervical radiculopathy in a high impact/high frequency athlete for one-level disease (73.5%). However, only 58.8% responded that they would offer a CDR in this scenario. Regarding spinal cord compression, consensus was not achieved that CDR is an acceptable treatment for a high impact/high frequency forces athlete for one-level disease with cord compression with/without myelopathy (47.1%). The most common reasons behind not offering a CDR included certainty of the anterior cervical discectomy and fusion (ACDF), safety concerns (eg, adequacy, efficacy, stability), and lack of data/evidence. Postoperatively, following a one-level CDR for myelopathy or radiculopathy, 57.6% of participants responded that they would advise the athlete may return to high impact/high frequency sport, whereases following a two-level CDR, only 23.5% of all participants responded they would advise the same. For one-level CDR, the most endorsed timelines for return to practice were 6 weeks (26.5%) and 3 months (26.5%) and for games was 3 months (41.2%). For two-level CDR, the most endorsed timeline for return to practice was 3 months (26.5%) and for games was 3 months (41.2%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Consensus was achieved that CDR is an acc","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of primary versus revision TLIF following decompression alone in degenerative spondylolisthesis: a retrospective propensity score matched study.","authors":"Sarthak Mohanty, Tomoyuki Asada, Tejas Subramanian, Kevin J DiSilvestro, Chad Z Simon, Nishtha Singh, Kasra Araghi, Olivia C Tuma, Maximilian K Korsun, Avani Sudhir Vaishnav, Eric Mai, Joshua Zhang, Cole T Kwas, Myles R J Allen, Eric T Kim, Annika Bay, Sheeraz A Qureshi, Sravisht Iyer","doi":"10.1016/j.spinee.2025.05.012","DOIUrl":"10.1016/j.spinee.2025.05.012","url":null,"abstract":"<p><strong>Background: </strong>Degenerative grade 1 spondylolisthesis is associated with lumbar instability, typically addressed with decompression and fusion to prevent iatrogenic instability. The SLIP trial indicated that decompression-only patients benefit significantly from early reoperation for instability. Yet, it's unclear how these revision patients' outcomes compare to those undergoing primary fusion.</p><p><strong>Purpose: </strong>To evaluate whether outcomes were inferior among patients receiving revision transforaminal lumbar interbody fusion (TLIF) after prior decompression in the setting of degenerative, grade 1 spondylolisthesis when compared to those undergoing primary TLIF for grade 1 spondylolisthesis.</p><p><strong>Study design/setting: </strong>Retrospective cohort study.</p><p><strong>Patient sample: </strong>Patients with grade 1 spondylolisthesis at L4-L5 or L5-S1 who underwent TLIF between 2018 and 2023 and had complete 1Y clinical follow-up and 6-month (6M) patient reported outcomes(PROs) were included.</p><p><strong>Outcome measures: </strong>PROs (ODI, PROMIS, SF-12, VAS Pain) and Clinical (Readmission and Reoperation at 6-week [6W], 6M, and 1Y).</p><p><strong>Methods: </strong>No predictors for missing data were identified. Comparisons were made between primary fusion patients and those with prior decompression now undergoing revision TLIF. Bias was minimized via 2:1 propensity score matching (PSM) for age, comorbidities (CCI), slip percentage, slip translation, angular change, anterior and posterior disc height (ADH and PDH respectively), facet diastasis and cysts, and facet orientation-termed spondylolisthesis characteristics. Unmatched PROs and clinical outcomes were analyzed with a mixed-effects (ME) model and chi-Squared test, while matched PROs and clinical outcomes employed an ME model and conditional logistic regression.</p><p><strong>Results: </strong>About 285 patients (55.4% female, mean age 60.80±0.73, CCI of 2.10±0.09, and 35.1% current/former smokers) were included. Spondylolisthesis slip was 13.11%±0.99% with mean translation in flexion/extension of 1.60±0.19 mm. Compared to revision patients (N=42, 14.7%), primary fusion patients (N=243, 85.3%) were younger (59.70±0.77 vs. 67.20±1.76) and had a lower prevalence of active smoking (2.48% vs. 11.90%), but showed no differences in slip percentage (p=.480), translation in flexion/extension (p=.778), ADH (p=.578), PDH (p=.991), facet diastasis (p=.132), facet cysts (p=.550), or angular change across L3-S1. Preoperatively, PROs were comparable across all domains. At 1-year postop, no differences were observed in back pain (p=.430), leg pain (p=.346), SF-12 PCS (p=.976), MCS (p=.737), PROMIS Score (p=.063), or ODI (p=.362). The PSM cohort, matched for age, CCI, and spondylolisthesis characteristics, showed standardized differences of less than 0.10 for all demographics, baseline PROs, and spondylolisthesis characteristics, aside angular change at L5-S1 (3.05 ","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vancomycin powder mixed with autogenous bone graft and bone substitute may decrease the deep surgical site infections in elective lumbar instrumented fusion surgery for degenerative disorders: a prospective randomized study","authors":"Shih-Tien Wang MD ,&nbsp;Hsi-Hsien Lin MD ,&nbsp;Yu-Cheng Yao MD ,&nbsp;Nicole Huang PhD ,&nbsp;Wei Hsiung MD ,&nbsp;Ming-Chau Chang MD ,&nbsp;Chien-Lin Liu MD ,&nbsp;Po-Hsin Chou MD, PhD","doi":"10.1016/j.spinee.2025.05.001","DOIUrl":"10.1016/j.spinee.2025.05.001","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background Context&lt;/h3&gt;&lt;div&gt;Deep surgical site infections&lt;span&gt; (DSSI) following lumbar instrumented fusion surgery are associated with considerable morbidity. Intraoperative application of vancomycin&lt;span&gt; powder (VP) has been widely used to prevent DSSI; however, the effects of VP mixed with local autogenous bone graft&lt;span&gt; (ABG) and bone substitute on DSSI prevention and bone fusion remains unclear.&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;To examine the effects of VP mixed with ABG and bone substitute on DSSI and fusion rate.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design/Setting&lt;/h3&gt;&lt;div&gt;A prospective randomized case-controlled study at a single medical center. (ClinicalTrials.gov Identifier: NCT03883022).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patients’ Sample&lt;/h3&gt;&lt;div&gt;&lt;span&gt;Adult patients who underwent decompression along with instrumented fusion surgery for a degenerative lumbar condition were recruited from October 2017 to May 2023. Patients were randomly allocated to vancomycin (n=357) or control (without vancomycin) (n=348) groups. In the vancomycin group, 1 g of &lt;/span&gt;antibiotic powder was used for 2- and 3-level fusions (no 1 level fusions?) while 2 g was used for &gt;3-level.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes Measures&lt;/h3&gt;&lt;div&gt;The primary outcome was DSSI within 90 days after index surgery. Secondary outcomes included surgical and vancomycin-related complications, functional outcomes and bone fusion.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;All patients were followed up with plain spine radiographs at 1, 2, 3, 6, and 12 months after surgery. The definition of DSSI was based on the Centers for Disease Control and Prevention criteria for SSI. Posterolateral fusion was assessed using the Lenke criteria and interbody fusion was assessed using the Brantigan-Steffee-Fraser (BSF) definition. Solid fusion was defined as an angular change of &lt;5° of the fused segments in supine dynamic flexion and extension lateral radiographs, Lenke grade A and B or BSF-3 definition. Antibiotic concentrations in the vancomycin group were measured in the serum and at the surgical site in the drain on days 1 and 3 after the index surgery. Functional outcomes were evaluated by Oswestry Disability Index&lt;span&gt; (ODI) and visual analog scale (VAS) for leg pain.&lt;/span&gt;&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In total, 357 and 348 patients were enrolled in the vancomycin and control groups, respectively. Mean patient age was 67.7±11.0 years and 63.0% were female. There were no DSSIs in the vancomycin group and five in the control group (0 vs 1.4%, p=.029). All five patients with DSSI had diabetes (100%). None of the patients with diabetes in the vancomycin group developed DSSI (0/119 vs 5/105 in control group, p=.021). Postoperative serum vancomycin levels were undetectable and no vancomycin-related complications were observed. The mean vancomycin concentrations at surgical site in the drain were 524.5±209.9 μg/mL and 217.4±97.2 μg/mL on postoperative days 1 and 3, respectively (m","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 9","pages":"Pages 1866-1876"},"PeriodicalIF":4.7,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a novel survey measuring lumbar activity levels: the Hospital for Special Surgery Core Health Evaluation-Lumbar Activity Rating Scale (HSS CHEV-LARS).","authors":"Eric R Zhao, Luis Colon, Kasra Araghi, Olivia C Tuma, Aiyush Bansal, Troy B Amen, Jung Kee Mok, Tomoyuki Asada, Austin C Kaidi, Gregory S Kazarian, Stephane Owusu-Sarpong, Quante Singleton, Farah Musharbash, Kevin J DiSilvestro, Kristin Halvorsen, Michael Parides, Evan D Sheha, James E Dowdell, Kyle W Morse, Philip K Louie, Todd J Albert, Francis C Lovecchio, Han Jo Kim, Sheeraz A Qureshi, Sravisht Iyer","doi":"10.1016/j.spinee.2025.05.005","DOIUrl":"10.1016/j.spinee.2025.05.005","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background content: &lt;/strong&gt;Preoperative activity level provides a key baseline metric to evaluate postoperative recovery. Preoperative physical therapy also may positively impact length of stay and postoperative mobility after spine surgery. While there are surveys measuring activity levels in other areas of orthopedics (eg knee, shoulder, ankle), there are no such validated surveys in spine surgery. Stratifying patients by preoperative activity level may help guide treatment decisions such as conservative versus surgical management and decompression alone versus fusion in select patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To develop and validate an activity rating scale for lumbar spine patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Phased prospective validation study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Item Generation/Item Reduction/Pilot-Testing Phases: clinic patients ≥18 years with lumbar pathology and no prior lumbar surgery. Validation phase: volunteer respondents ≥18 and ≤89 years currently in the United States.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;demographics (age, sex, body mass index [BMI]), level of activity, Oswestry disability index (ODI), patient-reported outcomes measurement information system physical function computer adaptive test (PROMIS PF CAT).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In phase 1 (item generation), 40 patients were interviewed on activities that involve and are most limited by their low back symptoms. Responses were used to generate a list of 12 activities. In phase two (item reduction), 40 separate patients rated activities on a scale from 1 to 10 for \"importance\" and \"difficulty\". Correlation matrices and clinical judgement were used to generate a pilot survey. In phase 3 (pilot-testing), 40 separate patients provided feedback on clarity, structure, and relevance to generate a final survey: The Hospital for Special Surgery Core Health Evaluation - Lumbar Activity Rating Scale (HSS CHEV-LARS). In phase 4 (validation) 205 respondents from a secure research crowdsourcing platform (CloudResearch&lt;sup&gt;TM&lt;/sup&gt;) completed the HSS CHEV-LARS, ODI, and PROMIS PF CAT. The same respondents were asked to complete the HSS CHEV-LARS again 1 week later to assess test-retest validity via intraclass correlation coefficient (ICC). Construct validity was assessed by correlating the HSS CHEV-LARS with ODI, PROMIS PF CAT, age, and BMI. Internal consistency was assessed with Cronbach's alpha.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The 12 activities from phase 1 involved q1) elevation change q2) running q3) walking q4) standing q5) sitting q6-7) carrying objects below and above the waist q8) repetitive or heavy lifting q9) moving objects across the floor q10) bending forward or down q11) handling objects overhead q12) twisting. Q2 was removed due to low importance; q5) was removed due to low difficulty; q3/q4 and q6/q7 were combined due to high correlations; q8/q10 were combined due to movement similarity; q9 was removed due t","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does intraoperative antiseptic solution soaking reduce microbial contamination in spine surgery? A randomized controlled trial","authors":"Yuan-Fu Liu MD ,&nbsp;Yu-Chia Hsu MD ,&nbsp;Po-Lin Chen MD, PhD ,&nbsp;Hao-Jun Chuang MD ,&nbsp;Ting-Yuan Tu PhD ,&nbsp;Chao-Jui Chang MD ,&nbsp;Yu-Meng Hsiao MD ,&nbsp;Cheng-Li Lin MD, PhD","doi":"10.1016/j.spinee.2025.05.002","DOIUrl":"10.1016/j.spinee.2025.05.002","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Surgical site infections&lt;span&gt;&lt;span&gt; (SSIs) are a significant complication in spine surgery, particularly in instrumented procedures, leading to increased morbidity and healthcare costs. Despite standard preoperative disinfection protocols, bacterial contamination remains prevalent. Strategies such as intraoperative antiseptic irrigation have been explored to mitigate contamination, yet the comparative efficacy of different &lt;/span&gt;antiseptic solutions remains unclear.&lt;/span&gt;&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;This study aimed to evaluate the effectiveness of intraoperative antiseptic solution soaking with normal saline (NS), povidone-iodine (PVP-I), and chlorhexidine gluconate (CHG) in reducing bacterial contamination in lumbar instrumented fusion surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;div&gt;A single-center, single-blinded, randomized controlled trial was conducted at a tertiary medical center in Taiwan.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;&lt;span&gt;A total of 105 patients undergoing posterior lumbar interbody fusion surgery were enrolled and randomly assigned to three groups: NS (n=35), PVP-I (n=35), or CHG (n=35). Patients with prior lumbar procedures, known allergies to antiseptics, previous spinal infections, &lt;/span&gt;trauma, or tumors were excluded.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;The primary outcome was the reduction in bacterial contamination, assessed via intraoperative cultures from three sites—superficial tissues, deep tissues, and implant surfaces—before and after antiseptic irrigation. Secondary outcomes included the incidence of postoperative SSIs and clinical complications over a 6-month follow-up period.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;&lt;span&gt;&lt;span&gt;&lt;span&gt;Patients were randomized into three groups, each receiving a 3-minute soak with the assigned antiseptic solution before wound closure, followed by normal saline irrigation. Swab samples were collected pre- and postirrigation for &lt;/span&gt;bacterial culture and &lt;/span&gt;16S rRNA PCR analysis. Statistical analysis was performed using &lt;/span&gt;logistic regression and Bonferroni correction for multiple comparisons.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among 105 patients, preirrigation bacterial culture positivity rates were 49.5% in superficial tissues, 31.4% in deep tissues, and 32.4% on implants. Postirrigation, NS showed no significant bacterial reduction, while PVP-I reduced superficial contamination (55.0%, p=.015) but no significant effect in deeper tissues and implants. CHG showed the greatest bacterial reduction, significantly outperforming NS (OR: 0.06, 95% CI: 0.01–0.54, p=.011) and PVP-I (OR: 0.06, 95% CI: 0.01–0.56, p=.012) on implant surfaces. Despite these differences in culture rate, SSI rates remained low and comparable among groups (p=.72), with no reported antiseptic-related complications.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSION&lt;/h3&gt;&lt;div&gt;This study confirms that bacterial contamination remains high despite stand","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 9","pages":"Pages 1857-1865"},"PeriodicalIF":4.7,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}